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Angola
Three years after Angola's civil war ended, its people still face a weakened health system and difficulties in movement due to deteriorated and often heavily mined roads. Angolan authorities, with the support of the international community, have launched a massive effort to reconstruct health and transportation systems. The population's nutritional situation is also improving. Yet despite these developments, 70 percent of the population remains without basic health care. Angola also has one of the world's highest child mortality rates — one in four children dies before turning five. MSF's work in Angola has changed dramatically as a result of the modest progress that has been made in various areas. While teams continue to support Angolan health authorities' efforts to provide basic health services, more and more responsibility is being transferred back to local authorities. Today MSF is focusing on helping those with malaria, sleeping sickness, tuberculosis (TB) and most recently, HIV/AIDS, all diseases that receive little attention. In 2005 MSF also provided emergency assistance when the country was confronted with an outbreak of the deadly Marburg virus (see below). Treating those with malariaAs in many sub-Saharan countries, malaria is Angola's number one killer disease, with the heaviest toll among children under five. More than half of all primary health care consultations involve malaria. In Kuito, MSF runs a pediatric malaria-treatment center that admits as many as 750 children a month during the annual six-month malaria peak. In addition, a large number of health posts located in the provinces of Bie, Bengo, Lunda Norte, Malanje, Cuanza Sul, Moxico, Huambo, Cuanda Cubango, Huila and Uige carry out thousands of malaria consultations each month with the support of MSF, which provides drugs, rapid- testing kits and regular supervision and training. In June 2005, in Caala, a city in Huambo province, MSF transferred its support of 13 health posts — along with a six month supply of medicines and rapid testing kits — to the ministry of health. Screening for sleeping sicknessVirtually eliminated in the 1960s, sleeping sickness is making a vengeful comeback in Angola and other parts of Africa. Existing treatments for this fatal, parasitic disease are old, toxic and unsuited for resourcepoor settings. MSF operated a sleeping sickness project in Caxito, the capital of Bengo province, and in Camabatela, a municipality in Cuanza Norte province. In addition to admitting patients, MSF conducted active screening campaigns to identify and treat new patients, mostly in remote areas. MSF screened more than 8,000 people and treated a total of 163 patients in 2004. In the first half of 2005, the team screened 3,000 people and treated 23 for the disease. In mid-2005, due to lower-than-expected incidence, MSF handed over activities to the ministry of health and other collaborating partners. TB and HIV/AIDS increasesTB is a major public health problem in Angola. According to national agencies, the number of reported TB cases increased almost threefold, from approximately 11,500 to more than 31,000, from 1999 to 2002. MSF cares for TB patients in Bie, Lunda Norte, Cuanza Sul, Moxico, Malanje and Huila provinces with more than 1,300 people under treatment. Angola is at a critical point in its fight against the HIV/AIDS epidemic. While UNAIDS estimated adult prevalence at 3.9 percent at the end of 2003, there is evidence of a growing number of HIV-positive pregnant women and the prevalence could rapidly increase once transportation routes reopen. MSF is now integrating HIV/AIDS care within its TB projects in Malanje, Bie and Huila provinces because of increasing numbers of patients with both illnesses. Caring for the most vulnerableToday MSF conducts a variety of primary health care activities — supporting health facilities and operating mobile clinics — in Malanje, Bie, Moxico, Cuanza Norte, Cuanza Sul, Lunda Norte, Huila and Uige provinces. The main illnesses treated continue to be malaria, respiratory tract infections and diarrhea. In April 2005, MSF's primary health care activities in Cuando Cubango and Zaire provinces were handed over to the ministry of health after 5 and 10 years, respectively. MSF has supported hospitals in the towns of Mavinga and Menongue, Cuando Cubango province; Camacupa, Bie province; and Luau, Moxico province. During 2005, MSF handed over responsibility for these projects to local authorities. MSF provides water and sanitation facilities in Moxico, Bie and Cuando Cubango provinces. Teams in Luau, Moxico province provided assistance to refugees from the Democratic Republic of the Congo and Zambia by carrying out screenings and consultations, health education and water and sanitation services until September 2005, when these activities were transferred to government authorities. MSF has worked in Angola since 1983.
When an epidemic of Marburg hemorrhagic fever was confirmed in March 2005 in Angola's northern province of Uige, MSF quickly mobilized resources, and the first MSF team arrived a few days later to assist local health authorities. Before the outbreak was brought under control in July 2005, more than 300 people had died, sporadic cases were still being found and a dozen patients were recovering from the illness. Marburg fever is closely related to the better known Ebola virus. Like it, Marburg is almost always fatal and is easily transmitted through body f luids. There is no cure for the illness, and its first symptoms are easily confused with malaria's symptoms. The MSF intervention included setting up and managing the isolation unit where patients were cared for, maintaining hospital infection control and reinforcing universal precautions. MSF also assisted with case finding and contact tracing, ensuring safe burial practices, and maintaining water and sanitation systems, including disinfection, and conducted needed community education and epidemiological monitoring and analysis. While most cases of Marburg were reported in Uige town, emergency units were also set up in Angola's capital city of Luanda; Songo and Negage in Uige province; and Camabatela, Cuanza Norte province. Given the infectious nature of the disease, MSF teams had to wear extensive bio-safety gear. This clothing was not only uncomfortable to work in but frightened local community members. While MSF teams initially faced difficulty being accepted locally, and even encountered overt aggression, the organization's efforts to sensitize the community to its work and to understand local beliefs and practices helped ease the situation. MSF took stock of the lessons learned in its attempt to adopt a sensitive, human approach while still battling one of the world's deadliest viruses. In July 2005, once the Marburg epidemic was controlled and local health staff could manage sporadic cases, MSF ended its involvement in the Marburg emergency operation. |
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Children pass time at the aTB sanatorium in Kuito, Bie province, Angola. Photo © Carl De Keyzer and Magnum Photos